00548 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); intrathoracic procedures on the trachea and bronchi

Name of the Procedure:

Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); intrathoracic procedures on the trachea and bronchi.

Summary

This procedure involves the use of anesthesia to ensure that patients are pain-free during surgeries on the lungs, the lining around the lungs (pleura), the diaphragm, and the area between the lungs (mediastinum). It also covers anesthesia for surgical procedures on the windpipe (trachea) and large airways (bronchi).

Purpose

The main goal is to provide pain relief and ensure the patient's comfort during complex chest surgeries. Anesthesia helps control pain, minimize movement, and maintain vital functions during operations that treat conditions like lung cancer, pleural diseases, diaphragmatic hernias, and tracheal/bronchial disorders.

Indications

• Lung tumors or cancer
• Pleural diseases (e.g., pleural effusion, pleuritis)
• Diaphragmatic hernias
• Mediastinal masses or infections
• Tracheal or bronchial strictures, tumors, or infections

Preparation

• Patients are usually instructed to fast for 6-8 hours before the procedure.
• Medication adjustments may be necessary, particularly for blood thinners.
• Preoperative tests might include blood tests, chest X-rays, CT scans, echocardiograms, and pulmonary function tests.
• Patients will have a pre-anesthetic consultation to discuss their medical history and anesthesia plan.

Procedure Description

1. Pre-Anesthesia: The patient is taken to the operating room and connected to monitors for heart rate, blood pressure, and oxygen levels.
2. Anesthesia Induction: Intravenous medications are administered to induce general anesthesia, rendering the patient unconscious.
3. Airway Management: An endotracheal tube is inserted into the windpipe to secure the airway and deliver oxygen and anesthetic gases.
4. Maintenance: Anesthetic gases and IV medications are administered to keep the patient unconscious and pain-free. Muscle relaxants may also be used.
5. Monitoring: Continuous monitoring of vital signs and adjustments of anesthetic levels as needed.
6. Emergence: After the surgery, anesthetics are gradually reduced, and the patient is awakened and the airway tube is removed once they can breathe independently.

Duration

Anesthesia duration depends on the specific surgical procedure but typically lasts between 2 to 6 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Anesthesiologists or nurse anesthetists
• Surgeons specialized in thoracic procedures
• Surgical nurses and technologists

Risks and Complications

• Common risks: Nausea, vomiting, sore throat, dizziness
• Serious but rare risks: Respiratory complications, allergic reactions, cardiovascular issues, nerve damage

Benefits

The primary benefit is a pain-free, stress-free surgical experience, allowing for complex thoracic surgeries to be performed safely. Patients typically begin noticing benefits from the surgery a few days to weeks after the procedure, depending on the specific operation.

Recovery

• Postoperative monitoring in a recovery room or intensive care unit.
• Pain management with medications.
• Breathing exercises and physiotherapy to aid lung function recovery.
• Typical recovery duration ranges from one to several weeks, with activity restrictions and follow-up appointments as directed by the healthcare team.

Alternatives

• Regional anesthesia (e.g., epidural or spinal block) may be an option for some patients.
• Less invasive treatments or palliative care, depending on the situation.
• Each alternative has its own risks, benefits, and suitability depending on the patient's condition.

Patient Experience

Patients will be unconscious during the procedure and are expected to wake up in the recovery room. Post-operation, they may experience pain managed with medications, and they may feel groggy or nauseated initially. Comfort measures, including pain control and supportive care, are routinely provided.